the no longer competent office of coroner, our good cultured mayor, a gentleman and author vetoed fit for the reason that the new law was not perfect. It was not pronounced perfect by anybody; no law is nor ever was. That is why it appears he prefers something that always was and is, and always will be perfect, namely, the absurd in competency and anachronism of the coronor's office. That is perfect. I have not hesitated to express myself strongly and positively, for I have been called upon to speak to you about the relation of pediatrics to other sciences and arts-politics included, than which there is no more profound, practical and indispensable science and art. The greatest histcrical legislators understood that perfectly well, when they knew how to blend hygiene and religion with their social and political organizations.

One of the greatest questions which concerns at the same time the radical statesman, the humanitarian and the pediatrist, is that of the excessive mortality of the young. The Paris Academy of Medicine enumerated in its discussions of 1870 the following amongst its causes: Poverty and illness of the parents, the large number of illegitimate births, inability or unwillingness on the part of mothers to nurse their offspring, artificial feeding with improper material, the ignorance of the parents in regrad to to the proper food and hygiene, exposure, absence of medical aid careless selection of nurses, lack of supervision of baby arms, general neglect and infanticide. If there be anybody who is not quite certain about the relationship of sciences and arts, he will still be convinced of the correlation and co-operation of ignorance, indolence, viciousness and death, and shocked by the shortcomings of the human society to which we belong. Most of them should be avoided. Forty per cent of the mortality of infants that die before the end of the first year takes places in the first month. That is mostly preventable. A few years ago the mortality of the infants in the Mott Street barracks of New York City was 325 per mille. Much of it is attributable to faulty diet.*

Amongst those who believe in the omnipotence of chemical formulae, there prevails the opinion that a baby deprived of mother's milk may just as readily be brought up on cow's milk; that is easily disproved. Berlin they found that amongst the cows'milk fed babies under a year the mortality

In

Measures taken for the purpose of obtaining wholesome milk are not quite new. Regulations were given in Venice, 1599, for the sale of milk. Milk and its products of diseased animals were forbidden. The Paris municipality of 1792 enjoined the farmers to give their cows healthy food. Coloring and dilution of milk were strictly forbidden and in 1792 they knew in France how to punish transgressors.

was six times as great as amongst breast-fed infants. Our own great cities gave us similar, or slightly smaller, proportions, until the excessive mortality of the very young was somewhat reduced by the care bestowed on the milk, introduced both into our palaces and tenements. Milk was examined for bacteria, cleanliness, and chemical reaction. It was sterilized, pasteurized, modified, cooled, but no cow's milk was ever under the laws of nature changed into human milk, and with better milk than the city of New York ever had, its infant mortality was greater this summer than it has been in many years.

That hundreds of thousands of the newlyborn and small infants perish every year on account of the absence of their natural food is a fact which is known and which should not exist. Why do we kill those babies or allow them to be killed? Why is it that they have no breast milk? A large number of women work in fields, still more in factories. That is why their infants cannot be nursed, are farmed out, fed artificially, with care or without it, and die. It is the misrule prevailing in our conditions which compels them to withhold milk from the infant while they are working for what is called bread for themselves and their families. Many of these women, it is true, would not have been able to nurse their newly-born, or their own physical condition was always incompetent. The same may be said of women in all walks of life. Insufficient food, hard work, care, hereditary debility and disease, tuberculosis, alcoholism of the woman's own parents, modified syphilis or nervous diseases in the family-aye, the inability of her own mother to nurse her babies, are ever so many causes why the mother's fountain should run dry. Statistics from large obstetrical institutions (Hegar) prove that only about 50 per cent of women are capable of nursing their offspring for merely a few weeks. In the presence of such facts what are we to say of the refusal of well-situated and physically competent women to nurse their infants I do not speak of the "400," I mean the 400,000 who prefer their ease to their duty, their social functions to their maternal obligations, who hire strangers to nurse their babies, or worse yet, who make-believe they believe the claims of the infant food manufacturers, or are tempted by their own physicians to believe that cow's milk casein and cow's milk fat may be changed into woman's casein and fat, that chemistry is physiology, that the live stomach is like a dead laboratory bottle, that the warmth of the human bosom and that of a nursing ask are identical, and that cow's milk is like human milk when it carries the trademark "Certified," or "Mod

fied." Physiological chemistry itself teaches that the phosphorus combinations in woman's milk, in the shape of nuclein and lecthin are not contained in cow's milk, and that the large amounts of potassium and sodium salts contained in cows milk are dead weights rather than nutrients, and particularly the large amount of calcium phosphate occurs in a chemical, not in a physioloigcal combination. Only lately, by no means for the first time, Schlossmann and Moro (Meuch. med. Woch., 1903, No. 14), have again proved that the albuminoids of woman's and cow's milk are essentially different, both in their lactalbumin and the globulin, and Escherich and Marfan, that every milk has its own enzymes.

The quantitive and many of the qualitative differences of cow's and human milk have been known a long time. No addition or abstraction of salts, no addiion of cow's fat will ever change one into the other. But it ap

pears that every new doctor and every new author begins his own era. There is for most of modern writers no such thing as the history of medicine or of a specialty, or repsect of fathers or brothers. In modern books and essays you meet with footnotes and quotations of the productions of yesterday that look so erudite, but also with the new discoveries of old knowledge which you would recognize if the quotation marks had not been forgotten by accident. So it has happened that many learn for the twentieth time that the knowledge of the minimum amount of required food is a wholesome thing, that the amount of animal fat in infant food is easily overstepped, that we have discovered that the Dutch had a clever notion when they fed babies on buttermilk with reduced fat; we are even beginning to learn what our old forefathers practised a hundred years ago, and physiologists taught a third of a century ago-namely, that the newly-born and the very young infant not only tolerate small quantities of cereals, but they improve on it. Indeed, the names of Schiller, Korowin and Zweifel have been rediscovered. We have also learned-just lately, it appears-what was always known, that morning and night, idleness and work, health and illness, while altering the chemical composition of woman's milk, do not necessarily affect its wholesome character. We are beginning to learn that it is impossible to feed a baby on fanatical chemical formulae, for they are not prescribed by Nature, which allows latitude within certain limits. We are even beginning to learn that if that were not so there would be no artificially-fed babies alive, and possibly very few participants in the St. Louis Congress of Arts and Sciences.

The inability or reluctance of women to nurse their own infants is a grave matter. From a physical, moral and socio-political point of view there is only one calamity still graver, that is to refuse to have children at all. It undermines the health of women, makes family life a commercial institute or a desert, depopulates the child world, reduces original Americans to a small minority, and leaves the creation of the future America in the hands of twentieth century foreigners. The human society of the future will have to see to it that no poverty, no cruel labor law, no accident, no luxurious indolence, must interfere with the nursing of infants. I believe in the perfectibility of the physical and moral conditions of the human race. That is why I trust that society will find means to compel able-bodied women to nurse their own infants. Infants are the future citizens of the republic. Let the republic see that no harm accrue from the incompetence or unwillingness to nurse. Antiquity did not know of artificial infant feeding. The first information of its introduction is dated about 1500. Turks, Arabs, Armenians, and Kurds know of no artificial feeding today. It takes mod, ern civilization to expose babies to disease and extinction. I know of no political or social question of greater urgency than that of the prevention of the wholesale murder of our infants caused by the withholding of proper nutriment. May nobody, however, feel that all is accomplished when an infant has finally completed his twelve months. Society and family owe more than life-they owe good health, vital resistance, and security against life-long invalidism.

But even willing mothers may have no milk. We require a stronger race, and one that physicially is not on the down grade.

The nursing question is a social and economic problem like so many others, like the childbearing question, that confront modern civilization.

The Treatment of Pneumonia.

DR. F. D. REESE enters a plea against the use of alcohol in pneumonia. Its administration he says (Med. Record), cannot be justified by good any scientific reason, and there is no indication for its use that cannot be met by some other drug or remedy. The treatment he employs is eliminative, and comprises a hot foot bath and calomel as soon as the disease is suspected, together with small doses of salicylate of sodium. When the diagnosis is established, acetate of potassium is given for its action on the kidneys, together with liquor ammoniae acetatis to relieve the right heart. If the temperature reaches 105 deg., cold sponging or cold pack to the chest. Abdominal distention is controlled by the usual measures, and careful attention is directed to the feeding, which should not be too often or too much. The pulse must be closely studied, and it is its quality rather than its rate that should be regarded. A soft pulse should be strengthened with strychnine, digitalis, and rest, and a hard pulse requires Dover's powder and nitrogloyerine. Rest is of the greatest importance, and the patient should be disturbed as seldom as possible. The prodromal stage is much longer than is usually supposed, and the disease is commonly ushered in by a more or less protracted period of malaise and indisposition. The author has treated twenty-one successive cases by this method, with two deaths, both of which were caused by other conditions.

PRESIDENT ROOSEVELT has issued an order directing the Japanese system of wrestling to be introduced into the Naval Academy as an addition to the system of athletic training in use there.

IT IS conceded that there is still much that is discouraging in our results in the treatment of malignant disUndoubted prog

Treatment of Malignant Disease.

ease.

ress however, has been made in three notable directions, as pointed

out by Dr. Abbe, (Med. Record, Dec. 31): (1) In the recognition of the principle that carcinoma and sarcoma are primarily of local origin. This makes the cure almost certain when very early operation is done. (2) In recognizing the enormous value of increasingly extensive operation in advanced cases -widening the field of skin removal and lymphatic dissection. (3) In establishing the value of radiotherapy. Serum therapy is still sub judice, and antitoxin treatment and oöphorectomy have not gained a place among the list of surgical procedures for usual resort. Radiotherapy offers a more hopeful prospect, however, and furnishes an external stimulus of a type heretofore unused, which adds a measure of strength and control to the vital spark left in the decadent cells of the morbid growths. Phototherapy, as such, and even the much-talked-of ultra vio

let rays are yet without claim of value in true malignant growths, but there remain for consideration the Roentgen rays, the ionized rays and the rays from radium." The outcome of the application of these three forms of radiant energy has been that many tumors have been dissipated, some have been unaffected, there have been occasional recurrences and a few cures. One may summarize it by saying that we have gained both knowledge and hope. The author cites several cases he has successfully treated by these means, and he concludes that the Roentgen ray, radium, and the Piffard lamp emit somewhat the same influence and excite a grade of local reaction not at all like inflammation of usual type. From radium we may expect the greatest future results, for it alone may be used in deep structural disease, and with a promise of a large production of strong radium in Austria, the next year will reveal further fruits of research and treatment.

CATHETERISM IN PROSTATIC RETENTION. C. L. Squire describes a method of extemporaneously plotting a suitable curve for urethral instruments for cases with prostatic enlargement. A glass or cup measuring three and a quarter inches across the top is inverted over a piece of paper, and with tape measure held against its side, a pencil is made to describe a curve having a radius of four and three-sixteenths inches at the start. -Medical Record.

THE REVIEWER'S TABLE

Books, Reprints, and Instruments for this department, should be sent to the Editors, St. Louis.

THE DOCTOR'S RECREATION SERIES. 1. The Doctor's Leisure Hour, facts and fancies of interest to the doctor and his patient Edited by Dr. Porter Davies. 352 pages. 2. The Doctor's Red Lamp. A book of short stories concerning the doctor's daily life. Edited by Chas. Wells Moulton. 343 pages. In series of 12 volumes to appear monthly. Akron, Ohio: Saalfield Publishing Co. (Price, cloth, $2.50 per vol.: Half Morocco, 84 00 per vol.)

Any joke on the doctor is always appreciated by the laity, and it is a wholesome fact that we in the profession are not deficient in our sense of humor, even though we are its objects. In compiling these volumes the best raconteurs of the profession have been enlisted, and the success of the first two volumes insures that the series will be a source of great pleasure to us and to our friends. While humor plays a great part in the stories the range is so wide as to include stories of all sides of the medical existence. Experiences from real life most exquisitely humorous and most delicately pathetic are given space, with due attention to the middle ground between. In fact the editors and his collaborators have in a most satisfactory degree accomplished their purpose to collect a great amount of useful, curious and entertaining literature concerning the profession, a large part of which would eventually have been lost but for this undertaking.

No physician can make a mistake in leaving these volumes in his waiting-room and freely accessible to his patients, for brief and interrupted reading they are admirably suited, and at the same time they will serve as a most wholesome antidote to the tendency to various freaks and fads which have arisen in the treatment of the sick by other than regular methods. Utterly and aside from the pleasure that the doctor may have from the series in his own household, which is a sufficient reason for desiring them, he will find that their influence on his clientele is healthful to a degree that insures good which could not be accomplished by other means.

The work of the publisher has been well done, the volumes are handsomely and durably bound and will prove a valuable and attractive addition to any library.

H.

A PRACTICAL TREATISE ON DISEASES OF THE SKIN, By James Nevins Hyde, A.M., M.D., and Frank Hugh Montgomery, M.D. Seventh revised edition. Octavo, 938 pages. Profusely illustrated with engravings and plates in color and monochrome. New York and Philadelphia: Lea Brothers & Co. (Cloth $4.50 net; Half-Morocco $6.00 net.)

The seventh edition of this popular work presents the results of more thorough work than is usually done in revision, the whole text has been carefully gone over, all matter which had outlived its usefulness or was considered untimely was eliminated, a considerable part of the text was rewritten and addi

tions were made wherever it was found serviceable, the extent of the additions may be estimated from the fact that this edition contains about one hundred more pages than the last. The following subjects have been introduced: General Pathology of the Skin; Radio-Therapy and Phototherapy; Granulosis Rubra Nasi; Erythema Elevatum Diutinum; Ulcerative Granuloma of the Pudenda; the Psoriasiform Dermatoses; Dermatitis Vegetans, and others. A careful consideration of the value and technique in diseases of the skin of both the X-ray and the Finsen light makes one of the chapters of special value and interest. Throughout the volume both the metric and the apothecaries systems of weights and measures have been employed for the convenience of its readers. The bibliography of dermatololgy has, inconnection with the work, been most carefully prepared; by following the references the student may pursue each subject to the extent of reliable literature. The more generous use of illustration as a means to an understanding of the text is not the least of the advantages of the present edition over its predecessors.

It would seem to be superfluous to speak in detail of the points of worth of this work, of previous editions we have said much in approval, the present is in all points more worthy of such expressions. As a reference work or as a handbook of dermatology it so thoroughly and explicitly covers the ground that it leaves nothing to be desired. H.

MEDICAL SOCIETY OF THE MISSOURI VALLEY. In response to a cordial invitation from the Jackson County Medical Society, the semi-annual meeting of the Medical Society of the Missouri Valley will be held in Kansas City, Thursday, March 23, 1905. Those desirous of presenting papers should send their titles to the secretary not later than the first of February. Papers will ap

pear upon the program in the order in which they are received. An invitation has been extended to the presidents of the state associations within the territory embraced by the Missouri Valley, and to the profession in general, and an interesting and profitable meeting is expected. If you are not member of this association send in your application to the secretary. Initiation one dollar; annual dues one dollar.

S. GROVER BURNETT, M. D., President,
Kansas City.

CHAS. WOOD FASSETT, M. D., Secretary,
St. Joseph Mo.

REPORTS ON PROGRESS

Comprising the Regular Contributions of the Fortnightly Depårtment Staff.

INTERNAL MEDICINE.

O. E. LADEMANN, M. D.

A Case of Cramp Neurosis.— (Wernicke (Wernicke Berliner klinische Wochenschrift, No. 43, 1904). The author's case, an alcoholic 47 years old, is interesting, inasmuch as it closely resembled a congenital myotonia or Thompson's disease. Upon slight as well as sudden muscular activity tonic muscular spasms diffusely manifested themselves in different groups of muscles, rendering the individual completely helpless. These spasms did not ppear spontaneously. The electrical reactions of both muscles and nerves were reduced. Other factors might have played an etiologic role (they were not congenital), but it is the writer's conviction that the alcohol acted as the chief agent.

Research on the Cytologic Examinations of Exudates and Transexudates. Lewkowicz (Wiener klinische Wochenschrift, No 37, 1904) gives a thorough analysis of the publications of the subject and classifies the cytology of effusions into endotheliosis, mononucleosis, erythrocytosis, lymphocytosis and polynucleosis. Endotheliosis signifies a mechanical irritation, producing transudates, as in cardiac and renal affections, irritations. resltuing from neoplasms or traumatism. Mononucleosis is an indication of the presence of foreign cellular elements in some serous membrane. The macrophagocytosis in this variety is a defensive reaction of the organism to rid itself of these foreign elements. Erythrocytosis indicates a hemorrhagic process, either due to a rupture of some vessel, or the migration of blood corpuscles through the vessel wall in consequence of inflammatory changes in them. Lymphocytosis signify an inflammatory process of a serous nature and polynucleosis a purulent character. The writer asserts that by means of cytologic examination of effusions we are able to discover a pathologic process in some serosa; thus a meningitis can be differentiated from cerebral symptoms accompanying an infectious disease; a tuberculous meningitis from an intestinal trouble with toxic symptoms of the cerebral nervous system; locomotor ataxia and general paresis from a neurosis. The cytologic findings may vary in the course of the same disease, as a serous exudate may become purulent. Experience shows that certain pathologic conditions follow certain laws. For in. stance, in a case of lymphocytosis of the re

A

gion of the diaphragm or meninges it must be borne in mind that the majority of infections in these regions are of a tuberculous character. A lymphocytosis in the case of an exudate in the pleural cavity may be considered as an evidence of a tubercular process, although it does not positively exclude pneumococcus, influenza or staphylococcus inflammations or neoplastic changes. lymphocytosis in a meningitis indicates either a tubercular or luetic process. A polynucleosis does not exclude any of these processes and may signify a more extensive tuberculous or gummatous foci with necrotic changes. Particles of epithelium speak against tuberculosis. The polynuclear formula usually indicates some pyogenic process. It occurs also in a rheumatic or hydrophobic condition, heat stroke or possibly a malignant disease. A polynucleosis in cases of a transudate suggests an infarct in the lung. Mononucleosis or macrophagocytosis is an evidence favoring rheumatic or pneumococcus exudation.

A Case of Malarial Sciatica.-Huntington (Journal of the Royal Army Medical Corp, September, 1904) reports the case of a private in the U. S. marine service at Hongkong, 35 years old, who had been on duty in the Philippine Islands for several months, during which time he enjoyed perfect health. Without any apparent cause, such as trauma or exposure, he suddenly developed intense pain in the region of the sciatic nerve; the seat of greatest intensity was below the pelvis. The patient was relieved from duty and ordered to be put on sick list. Local applications of counter-irritants and hot water bottles were applied to the sensitive nerve with the internal administration of mild chloride to be followed by a saline purge. Under this treatment there were no signs of an improvement. The patient's blood was examined which revealed the presence of the estevo-autumnal malarial parasites. Upon the administration of full doses of quinine, both per os and subcutaneously into the sheath of the nerve, the pain and disability rapidly disappeared, terminating in a complete recovery. The author is of the opinion that injections of quinine into the sheath of the nerve has not been reported heretofore.

A Criticism of the Mosquito Theory of Infection in Malaria and Yellow Fever.-Cheinesse (Medical Press and Circular July 13, 1904) collects a number of facts in carefully reviewing the literature tending to dispute the constant relationship between the mosquito, yellow fever and malaria. The distributions of the anopheles by no means corresponds to